Archive for August, 2011


August 17, 2011

This is something I spend half of my day doing on many days and is not an easy task to come up with a clear diagnosis. It is even more difficult to be sure that you’re properly identifying risk. So I am sharing this information with you not so you can diagnose someone or even be experts at identifying children at risk of having an autism spectrum disorder (ASD). However, a brilliant psychologist from Great Britain who goes by the name Simon Baron-Cohen (see: Autism Research Center) published a study in approximately 2002 the demonstrated that the 20 children out of the 16,000 screen who failed to produce three specific behaviors went on to be diagnosed with having some form of an ASD. These were the three provider-administered items off the original seven item Checklists for Autism in Toddlers (CHAT). Essentially if a child 18 months of age or older could not look the direction the examiner pointed when she called the child’s attention, could not point to an object like a door when asked to, and could not perform a simple make-believe gesture such as pouring a cup of tea even after it was demonstrated, then that child had, by this study, a 100% chance of later being diagnosed with an ASD. The problem is many children out of the 16,000 children screened in general practice clinics did not fail all three of those items yet went on to get some diagnosis of an ASD later in life.

Thus, in this country the M-CHAT was developed, which is a 23 item questionnaire that anybody who knows the child well enough can answer and it will indicate whether or not a child should be sent to a professional like myself to confirm or disconfirm the diagnosis of an ASD. This tool “casts a wider net to recommend referral.”  Since I’ve been using these tools I have yet to find a child who failed all three of the provider administered CHAT items and did not get diagnosed with an ASD. There are not many things in my profession that have that high of an accuracy even if they might have a low specificity (namely they miss a lot).

Another factor that has that high of an accuracy in our field is that if a marriage has four negative attributes, then that there is a 95% chance they will be divorced within five years: these include stonewalling, criticalness, contempt and defensiveness. Again there are a lot of people that get divorced who didn’t necessarily have these four negative factors in their marriage; but if you have them you need to get help and you need to get it now!

That’s how I feel about these three items that are easy to attempt to do with a young child. You’re not going to catch everything but if a child cannot do these three things you should get them to a professional as soon as possible if they are 18 months of age or older. We know that identifying autism risk early and beginning intense (20-25 hours a week of engaging/interactive activities therapy and otherwise) intervention is what leads to the best outcomes. 

That’s the free stuff for this month and here are the links to the M-CHAT and even to John Gottman’s Four Horsemen of the Apocalypse. I will provide you with the M-CHAT in both English and Spanish.


Joseph McCoy, PhD



John Gottmann